Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts

Brandon Nokes, Beeletsega Yeneneh, Jake Maddux, Ryan C. Van Woerkom, Amelia Lowell, Hannelisa Callisen, Bhavesh Patel, Fadi Shamoun, F. David Fortuin, Patrick DeValeria, Ayan Sen

Research output: Contribution to journalArticle

Abstract

We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished. However, his peri-procedural hospital course was complicated by occluder device migration, which was retrieved with eventual surgical closure of the PFO. Nitric oxide has not demonstrated any statistically significant effect on mortality and only reported to transiently improved oxygenation in patients with hypoxemic respiratory failure. Our case demonstrates that inhaled nitric oxide may have a role in acute hypoxemic respiratory failure in a case with significant cardiac and pulmonary shunts.

Original languageEnglish (US)
Pages (from-to)98-102
Number of pages5
JournalRespiratory Medicine Case Reports
Volume24
DOIs
StatePublished - Jan 1 2018

Fingerprint

Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Nitric Oxide
Lung
Pulmonary Valve Insufficiency
Acrocephalosyndactylia
Patent Foramen Ovale
Equipment and Supplies
Artificial Respiration
Human Influenza
Allografts
Pneumonia
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts. / Nokes, Brandon; Yeneneh, Beeletsega; Maddux, Jake; Van Woerkom, Ryan C.; Lowell, Amelia; Callisen, Hannelisa; Patel, Bhavesh; Shamoun, Fadi; Fortuin, F. David; DeValeria, Patrick; Sen, Ayan.

In: Respiratory Medicine Case Reports, Vol. 24, 01.01.2018, p. 98-102.

Research output: Contribution to journalArticle

Nokes, Brandon ; Yeneneh, Beeletsega ; Maddux, Jake ; Van Woerkom, Ryan C. ; Lowell, Amelia ; Callisen, Hannelisa ; Patel, Bhavesh ; Shamoun, Fadi ; Fortuin, F. David ; DeValeria, Patrick ; Sen, Ayan. / Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts. In: Respiratory Medicine Case Reports. 2018 ; Vol. 24. pp. 98-102.
@article{cf3ae937eb284391a13992cb868ca9ed,
title = "Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts",
abstract = "We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished. However, his peri-procedural hospital course was complicated by occluder device migration, which was retrieved with eventual surgical closure of the PFO. Nitric oxide has not demonstrated any statistically significant effect on mortality and only reported to transiently improved oxygenation in patients with hypoxemic respiratory failure. Our case demonstrates that inhaled nitric oxide may have a role in acute hypoxemic respiratory failure in a case with significant cardiac and pulmonary shunts.",
author = "Brandon Nokes and Beeletsega Yeneneh and Jake Maddux and {Van Woerkom}, {Ryan C.} and Amelia Lowell and Hannelisa Callisen and Bhavesh Patel and Fadi Shamoun and Fortuin, {F. David} and Patrick DeValeria and Ayan Sen",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.rmcr.2018.03.017",
language = "English (US)",
volume = "24",
pages = "98--102",
journal = "Respiratory Medicine Case Reports",
issn = "2213-0071",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Inhaled nitric oxide mitigates need for extracorporeal membrane oxygenation in a patient with refractory acute hypoxemic respiratory failure due to cardiac and pulmonary shunts

AU - Nokes, Brandon

AU - Yeneneh, Beeletsega

AU - Maddux, Jake

AU - Van Woerkom, Ryan C.

AU - Lowell, Amelia

AU - Callisen, Hannelisa

AU - Patel, Bhavesh

AU - Shamoun, Fadi

AU - Fortuin, F. David

AU - DeValeria, Patrick

AU - Sen, Ayan

PY - 2018/1/1

Y1 - 2018/1/1

N2 - We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished. However, his peri-procedural hospital course was complicated by occluder device migration, which was retrieved with eventual surgical closure of the PFO. Nitric oxide has not demonstrated any statistically significant effect on mortality and only reported to transiently improved oxygenation in patients with hypoxemic respiratory failure. Our case demonstrates that inhaled nitric oxide may have a role in acute hypoxemic respiratory failure in a case with significant cardiac and pulmonary shunts.

AB - We present a case of refractory acute hypoxemic respiratory failure due to influenza B pneumonia with concomitant large intra-atrial shunt (IAS) and severe pulmonary regurgitation in a patient with Saethre-Chotzen syndrome with prior pulmonary homograft placement. Our patient's hypoxemia improved with inhaled nitric oxide as an adjunct to mechanical ventilation without requiring extracorporeal membrane oxygenation, and eventually a percutaneous closure with a 30 mm CardioSeal patent foramen ovale closure device was accomplished. However, his peri-procedural hospital course was complicated by occluder device migration, which was retrieved with eventual surgical closure of the PFO. Nitric oxide has not demonstrated any statistically significant effect on mortality and only reported to transiently improved oxygenation in patients with hypoxemic respiratory failure. Our case demonstrates that inhaled nitric oxide may have a role in acute hypoxemic respiratory failure in a case with significant cardiac and pulmonary shunts.

UR - http://www.scopus.com/inward/record.url?scp=85046663535&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046663535&partnerID=8YFLogxK

U2 - 10.1016/j.rmcr.2018.03.017

DO - 10.1016/j.rmcr.2018.03.017

M3 - Article

VL - 24

SP - 98

EP - 102

JO - Respiratory Medicine Case Reports

JF - Respiratory Medicine Case Reports

SN - 2213-0071

ER -